Use of Hydroxyurea with wheatgrass in Thalassaemia Major/Intermedia

Dr

Dr Vijay Ramanan ; MD, DM(Clinical Hematology)

Introduction B-thalassaemia is caused y mutations in the !-glo in locus resulting in loss o" or reduced hemoglo in # ( H #, $%!%) &roduction' Hydro(yurea, an antimeta olite, is a &otent inducer o"H ) &roduction' Mechanisms* +' # cytoto(ic e""ect resulting in stress erythro&oiesis, ,ith increased H ) le-els occurring as a result, is most commonly &ro&osed' %' More-com&le( e""ects in-ol-ing the &roduction o" nitric o(ide and the solu le guanylyl cyclase and cyclic guanosine mono&hos&hate.de&endent &rotein /inase &ath,ay gene ha-e een &ro&osed as eing res&onsi le "or this acti-ity'

Hydro(yurea thera&y is not associated ,ith considera le or steady e""ects on erythrocyte de"orma ility in !- thalassemia, ,hich may e(&lain the reduced res&onse to the drug in some &atients' 0heatgrass contains Chloro&hyll ,hich ma/es u& 1234 o" the solid content o" ,heat grass juice' Both chloro&hyll and hemoglo in share a similar atom structure' Hemoglo in consists o" iron, ,hile in chloro&hyll the metallic atom is magnesium' 5he elie-ers o" alternati-e system o" medicine claim that as chloro&hyll and hemoglo in are ali/e in atom structure, inta/e o" ,heat grass juice enhances hemoglo in &roduction' 5he treatment o" trans"usion de&endent -thalassemia im&oses a considera le urden on the "amily and institutional resources' In economically challenged nations, asic management(red cell trans"usions, iron chelation) is a distant dream "or the majority, ,ho, conse6uently, endure a &oor 6uality o" li"e' #ims and 7 jecti-es* 5o study the e""ect o" hydro(yurea and ,heatgrass in reducing the "re6uency o" lood trans"usion' Materials and Methods 5he study ,as carried out et,een 8anuary %339 and 8une %3+: on 2; &atients diagnosed as Betathalassaemia y H<=C' Randomly selected 2; &atients ,ith trans"usion de&endent B-thalassemia, ,ere recruited "or the study' <atients ,ere enrolled irres&ecti-e o" ,hether they ,ere recei-ing chelation thera&y ,ith de"iri&erone >des"errio(amine or not' # medical doctor e(clusi-ely on the roll o" thalassemia center maintained records o" the study su jects' ?(clusion criteria* +' Indisci&line in inta/e o" ,heat grass and hydr(yurea ta lets' 5his included interru&tion in inta/e e(ceeding :-days>,ee/ or more than 2-days month' %' Hydro(yurea ,as not administered elo, % years o" age' Methodology @ 7ur inde( case ga-e me insight into "ollo, u& in these case' He had een trans"used "or o-er :3 years ut "irst trans"usion ,as a"ter + year o" age'

@ I realised the real e""ect o" Hydro(yurea A>- 0heatgrass can only e judged y allo,ing the hemoglo in to "all u&to B to C gm4 ,ith &ulse rate ne-er crossing +%3>min' @ 5his le-el allo,s the inherent hemoglo in synthesis to start i'e H ) synthesis' I" a &atient doesnDt recei-e trans"usion "or o-er : months then it is translates into 5R#EF)GFI7E IED?<?ED?EC?'